Changes in physical function during intensive chemotherapy affect post-transplant survival in older adults with acute myeloid leukemia (AML), according to research presented at the 2023 Tandem Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR.
The researchers conducted a prospective cohort study to evaluate treatment-related changes in geriatric assessment and assessed their utility for predicting transplant outcomes in older adults with AML undergoing intensive chemotherapy prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT; Clinical Research Information Service number: KCT0002172).
The team designed a geriatric assessment battery with previously validated measures divided into 5 categories: physical function, including a short physical performance battery (SPPB); cognitive function; psychological function; nutritional status; and social support. Enrolled patients performed the geriatric assessment at diagnosis and the last follow-up visit before allo-HSCT.
The study included a total of 51 patients (median age, 63 years; range, 60-74 years) who underwent allo-HSCT after achieving complete remission.
The researchers found social support (P <.005) and self-reported physical and psychological function (P <.005 and P <.05, respectively) significantly worsened between the baseline and pre-allo-HSCT visits. They also observed a significant improvement in the distress scale (P <.05) but no significant difference in nutritional status, cognitive function, or objective physical function, including SPPB.
In a detailed assessment of patients (unimpaired or improved vs persistently impaired), the researchers found persistent impairment in SPPB (65.9% vs 28.6%; P =.006), tandem stand (63.3% vs 0%; P =.012), sit-and-stand (70.6% vs 41.2%; P =.009), and gait speed (68.4% vs 38.5%; P =.027) was significantly associated with inferior overall survival (OS).
They also found persistent impairment in SPPB (22.7% vs 71.4%; P =.003) and sit-and-stand speed (17.6% vs 52.9%; P =.005) was significantly associated with inferior non-relapsed mortality (NRM).
The team observed a trend toward superior OS (55.6% vs 28.6%; P =.268) and NRM (22.2% vs 71.4%; P =.117) in patients with improved SPPB compared to those with persistently impaired SPPB.
In a multivariate analysis, the researchers found persistent impairment of SPPB (hazard ratio [HR], 3.84; P =.011), tandem stand (HR, 5.69; P =.026), sit-and-stand (HR, 3.03; P =.014), and gait speed (HR, 2.66; P =.034) were significantly associated with inferior OS. They also found persistent impairment of sit-and-stand speed (HR, 4.22; P =.005) was significantly associated with inferior NRM.
“Among various changes in [geriatric assessment] domains, we revealed that patients with persistent impairment in the physical function in both [baseline and pre-transplant geriatric assessment] had poor survival outcomes, while [patients with improved physical function] had better outcomes,” the researchers concluded. “[Geriatric assessment] at pre-transplant and dynamic changes of physical function domain during intensively treated older adults with AML would improve risk stratification for transplantation decisions.”
Min GJ, Cho B, Kwaget D, et al. Changes in physical function during intensive chemotherapy in older adults with AML affect post-transplant survival. Presented at: 2023 Tandem Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR. Abstract 566.